Project Summary
Young men who have sex with men (YMSM)—ages 13 to 24 years old—are a priority population for HIV
prevention, as they represented nearly a quarter of all new HIV cases among men who have sex with men in
the United States in 2021. Moreover, YMSM represented 20% of new HIV cases in nonmetropolitan areas,
which is relevant given the focus on rural communities in the federal Ending the HIV Epidemic (EHE) plan. One
highly effective option for HIV prevention is Pre-Exposure Prophylaxis (PrEP). Still, PrEP use remains low
among YMSM, and for those who do take it, adherence to oral PrEP is often suboptimal. The recent United
States Food and Drug Administration’s approval of long-acting injectable (LAI) PrEP, cabotegravir, holds
promise to increase PrEP use and improve adherence. However, our understanding of PrEP preferences and
implementation needs for rural YMSM remains limited as the literature has primarily focused on older rural
samples or younger urban and national samples; more research is needed among rural YMSM to determine
how newly available LAI PrEP can be implemented for this population. Implementation science frameworks
can guide research into understanding factors influencing implementation of evidence-based practices like LAI
PrEP. As such, I propose a convergent mixed methods study to identify rural YMSM’s LAI PrEP preferences
and implementation needs informed by the Consolidated Framework for Implementation Research (CFIR). We
will conduct in-depth virtual interviews with rural YMSM (n = 35)—residing in a rural area within one of the
seven states with rural HIV burden listed in the EHE plan—to identify perceptions of LAI PrEP and acceptability
of various PrEP delivery models using reflexive thematic analysis (i.e., Aim 1). Concurrently, an online survey
will be fielded in the seven EHE states with rural HIV burden to identify groups of rural YMSM (n = 300) with
distinct PrEP modality preferences using latent profile analysis and exploring predictors of profile membership
(i.e., Aim 2). Finally, data from Aims 1 and 2 will be used for mixed methods integration data analysis to identify
implementation strategies, which will then be positively vetted by rural healthcare providers through
empowered deliberation (i.e., Aim 3). These identified strategies will be pilot tested in future research led by the
candidate. The training plan of this F31 award is designed to support Mr. Andrew M. O’Neil—an
underrepresented candidate—with foundational experience to support his development into an independent
investigator. The candidate will gain (1) foundational content and methodological expertise in implementation
science research in the field of HIV prevention, (2) competency in advanced quantitative data analyses, (3)
necessary skills in mixed-methods research and analysis, (4) training in responsible and ethical conduct in
research, and (5) individually-tailored professional development to support transition into a research-focused
career. The training plan includes coursework, training institutes, seminars, manuscript preparation, grant
writing, academic conferences, research activities, and mentorship to support post-graduation employment.
